Exploring Evidence-Based Practice and Challenges in Massage Therapy

There are many common misunderstandings about evidence based practice (EBP). It is not all about the reserach evidence, although that is a critical component.

Join us for a critical conversation with Nadine Hawyrluk, where we clear up the common misunderstandings surrounding evidence-based practice and the new standards set by the CMTBC. We dissect the requirements for maintaining an evidence-based approach, from staying up-to-date with the latest research to ensuring learning activities are taught by knowledgeable instructors. This is your chance to refine your learning plans and improve your practice to meet these  standards, ensuring your patients receive the best possible care.

In this episode, Nadine and I address the nuanced challenges and contradictions that arise in evidence-based practices, focusing on differentiating current trends and techniques from those that simply rehash anatomical knowledge. We delve into the ethical implications of providing accurate information to patients, highlighting the responsibility of healthcare professionals to avoid perpetuating unverified treatment narratives. This conversation is essential for any RMT committed to ethical and informed practice.

Curious about the claims surrounding prenatal care techniques like Spinning Babies? We scrutinize the evidence supporting such bold claims and discuss whether these practices fall within the scope of massage therapy. Moving toward the broader picture, we emphasize critical thinking in research evaluation, using polyvagal theory as a case study to demonstrate practical techniques for challenging preconceptions. Tune in to discover valuable resources for evidence-based practice and research evaluation, and arm yourself with the tools to scrutinize educational courses and their claims effectively. This episode is a must-listen for every RMT dedicated to providing high-quality, evidence-based care.

Chapters

• 0:08 Evidence-Based Practice in Massage Therapy
• 12:28 The Contradictions of Evidence-Based Practice
• 27:49 Examining Claims in Prenatal Care
• 42:19 Critical Thinking in Research Evaluation
• 50:32 Challenging Pseudoscience in Massage Therapy

Transcript

Eric: 0:08

Hello and welcome to another episode of Purves Versus. My name is Eric Purves. I'm a massage therapist, a course creator, a continuing education provider, a curriculum advisor and advocate for evidence-based massage therapy. In this episode, nadine Harluck joins me again for a discussion on the importance of having an evidence-based practice, and we also spend some time clearing up some common misunderstandings about evidence-based practice and what this means for the massage therapist. We also will go through the former CMTBC's resources for appraising evidence and explain why this is so important when choosing continuing education courses this is so important when choosing continuing education courses.

Eric: 0:46

If you enjoy listening to my podcast, please consider supporting it by making a donation, and you can do this by visiting buymeacoffeecom. Slash helloob. Purpose Versus is also available on YouTube, so please check us out there and subscribe. Thanks so much for being here and I hope you enjoy this episode. Hello and welcome to another episode of Purpose Versus.

Eric: 1:01

I'm excited to have Nadine back. Nadine was on so far the most popular episode we've ever had, where we talked about the new evidence-based practice standard for massage therapists in BC, and today we're going to talk more about the Standards of Practice and Resources page which the CMTBC had put out and talk about the requirements. And our focus today is going to be on learning activities and how an RMT is supposed to engage in these learning activities consistent with this new evidence-based practice standard. We think this is super relevant because our learning plans are supposed to be evidence-based and there's certain criteria they're supposed to follow, and if they don't, then we're actually not supposed to be using those in our learning plan. So we're going to have, I'm sure, a very interesting discussion today about what this might look like for potential learners. So thanks for being here, nadine.

Nadine: 1:55

Yeah, thanks for having me. I'm excited to dive into this.

Eric: 1:59

Let's just quickly talk about. You know, I'm just going to review for those that maybe didn't listen to the last episode just the requirements. I'm not going to read the whole thing, but there's basically four requirements set out incorporates evidence-based practice approach to support clinical decision-making when determining appropriate treatment plans. An RMT takes reasonable steps to maintain or remain up to date on research evidence to support an evidence-based practice. And number four, this will be our focus today an RMT engages in learning activities that A are informed by research evidence. B present information within RMT's scope of practice. And. C are taught by an instructor or presenter who holds appropriate knowledge and expertise to instruct RMTs in the context of a regulated health profession. I like that.

Eric: 3:01

I don't know if this is what's gonna be happening right now, though what are your thoughts, nadine?

Nadine: 3:06

um, I love how directed it is. I think it really lays out a great um guide for everyone. Yeah, I think there's going to be a transition there for people, um, because it is so new, it's like what does this mean? Do we have the skills to do these things? So I think you're right. I think it might take a bit of time.

Eric: 3:27

When we look at this. The thing that's so interesting, too, is now what we see is. We see evidence-based as being a term that's everyone using now, because that's what you're supposed to be using and that's what we're supposed to be taking. And it's important for us to understand that evidence-based could be a marketing ploy used to try to trick people or try to convince people that what they're taking is supported by latest evidence. And I will admit for myself that I use, or have been using, the term evidence-based for a very long time in much of the content that I teach, but I don't necessarily. I don't. I never thought of using it as a marketing boy. I wanted to always use it as I'm not going to teach you nonsense.

Eric: 4:15

Everything that's in this course is defensible by current best practices, current evidence which meets a certain criteria or certain standard For anyone listening. When you are looking to learn or build a learning plan if you're in BC or if you're I know we have listeners from all over the world if you are looking to learn continuing education or quality assurance or professional development whatever it's called where you live, it's really, really, really important to be critical of the evidence base. We'll put that in air quotes, even though no one can see because we're on a podcast. We'll put that in because that evidence base it's the minimum standard that we should have as a healthcare profession in terms of the information we are teaching each other, because the public deserves to receive current best evidence.

Nadine: 5:10

Yeah.

Eric: 5:11

When we're looking at this in terms of learning activities, continuing education courses. The other thing, too, is the point C, which talks about it's taught by an instructor or presenter who holds appropriate knowledge and expertise to instruct RMTs in the context of a regulated health profession, that's another one, too, is how is an RMT supposed to know or decide who has the right expertise or knowledge?

Nadine: 5:42

Right.

Eric: 5:44

I like that. It's there, but it's kind of vague. What are your thoughts on that?

Nadine: 5:49

Yeah, I think that could be a tricky one to to parse out, and I think we could have a decent discussion on that about what are? What are you looking for? Who do you want to see? What do you want to be able to find about that person? Are there certain credentials you want to see behind their name, um, or is experience enough? Like, what are what makes this person an authority on whatever topic that you're looking at?

Eric: 6:16

this is one thing, too, where I feel our profession really needs to step forward is just because you have 30 years of experience doesn't mean what you're teaching is valid or in terms of the science or narratives or explanations behind it yeah, yeah and this is a big problem that we see in the massage therapy schools a lot of them.

Eric: 6:40

I was recently at a presenting at a school to some graduating students and one of the biggest pieces of feedback I got from the students was that whenever they questioned their instructors during classes, during practical classes, it was this well, I've been doing this for 30 years. I've been doing this for 20 years. You know, I've been teaching this since the school was opened. Yeah so they're using this appeal to their experience or their right as being.

Nadine: 7:11

Just don't question me right that somehow experience trumps evidence or knowledge in some way yeah, and there has to be a blend.

Eric: 7:20

I would agree, I would think yeah, would you agree with that? Absolutely you've just been out of school for five years and you're teaching a course and you don't have a lot of expertise and maybe you don't have any extra education. Does that make an authority? Well, probably not, because you probably haven't built that clinical expertise yet. You don't maybe necessarily have an extra education.

Eric: 7:41

But if you've been practicing for 30 years and you've got a massive amount of clinical experience, which we know is part of that evidence-based framework which is super, super important, but you're the knowledge of your clinical expertise, your understanding of mechanisms, of mechanisms of effect, or what's actually happening when you're doing your treatments. That has to be based on evidence. That's based on science.

Nadine: 8:07

Yeah, and that's where I think things are often missing yeah, yeah, and I've I've heard a similar discussion happen among people looking for continuing education, where someone was like, oh well, I heard, this teacher is fantastic, they've been teaching for a while, really engaging, super great, super great. And then I said, yeah, but what are they teaching? It's like do you go to an instructor just because they're super charismatic and exciting, or do you go because you're going to learn something really valuable? So I think we just need to be careful, and especially if I think we can think about this too. What you're mentioning about evidence is that we can think about other industries where there was, like greenwashing, everything has eco stamped on it or whatever, right, and so you want to be careful. Is it really evidence-based or did they find some random citation and slap that on the bottom of their thing and it's not really related? So I think we just have to be, we have to go a little bit slower and think a little bit harder going forward I love your your comment there about greenwashing.

Eric: 9:12

Same thing with, like organics or organic. Yeah, it can just be like a, a term that gets thrown around, but it might not. It might just kind of meaningless, right, and we have to be mindful of that too in massage therapy and in our evidence-based stuff.

Eric: 9:29

That just because it says it is, doesn't mean that it is yeah just because you say something a million times doesn't mean that it is actually based. Yeah, big red flag for me if what I'm looking or critiquing. You know I'm skeptical of everything and those people that listen or know me, I don't believe much of anything. I don't even believe my own stuff some of the times because I'm skeptical of what I think I know which is fine and I'm the first to admit that no-transcript. That's a big red flag because that usually be challenged.

Eric: 10:18

If someone says to me hey, you know I'm interested in your stuff, you know can, can you send me some, some content on what it is that your course is about?

Eric: 10:29

I will always send them. Depending on what the course is about, I'll always send them a couple of PDFs or some links to some of the things that kind of create some of the main topics. I'm not gonna send them everything because a lot of the stuff that we have out there is we've got hundreds or dozens and dozens of references. I'm not gonna send them everything because a lot of the stuff that we have out there is we've got hundreds or dozens and dozens of references. I'm not gonna send all of those because you know, time consuming, it's a lot, but I would definitely send a few and say if you have any questions, please, please, reach out. Yeah, I never have a problem with that at all because I, as an instructor you know this is what I do for 99 of my living. Now is you have to be, you have to be open and honest with with the people that are coming to learn from you.

Nadine: 11:11

You should be okay to be questioned yeah, yeah, and I think this is kind of you can think of it like if you're in the store and you pick something off the shelf and you look at the ingredients list, um, you want to be choosy about what you are putting into your mind. You want to make sure that what is in the box is actually in the box, um, and and because it's a lot of time, energy and potentially money that you're spending on on putting these things into your mind and you want to make sure it's good, otherwise you're you're really risking investing in, maybe opinions, pseudoscience. You know that's a big risk.

Eric: 11:54

I would guess that if you looked at every single course that was being taught to RMTs across Canada, I would think that you could probably count on both hands how many of them would actually be properly evidence-based and meet a good standard of critique, and you probably still have quite a few fingers left over.

Nadine: 12:23

Yeah, so there's room for growth.

Eric: 12:25

There's a lot of room for growth. Yeah, that's just from me look, spending. I spent a lot of time looking and seeing what's out there and I think and a lot of the stuff says it's evidence-based. But evidence-based for what? So you see a lot of stuff out there too where people are talking about oh, this is a course on the the, you know, assessments of the lower leg or lower extremity or whatever Say it's a course like that. I've seen stuff like that out there and the person will go take a, people will go take that course and there's lots of time spent on anatomy and kinematics or joint kinematics and kinesiology and you know all the muscles and ligaments and tendons and those people get this kind of anatomy review. Well, that's evidence-based because there's hard like that's the science of how we move and where things are.

Eric: 13:14

But when I look at a course like that, I think, okay, what's the evidence for assessments in the lower extremity that are actually valid, reliable, have good clinical utility? There's like none you know you have. I believe lockman for the knee is the only one for acl which actually has good evidence to support it. If you're practiced and experienced, so you have an entire course on treating and assessing the lower extremity, but maybe the only evidence based about it is the actual anatomy right, you know, and oftentimes those courses will be taught with this perspective of, like I'm changing tissue and I'm loading this and we're releasing that. Where's the evidence for that other than just, oh, that's, I'm seeing a change and so therefore my narrative is valid?

Nadine: 14:06

Yeah.

Eric: 14:08

Which I think gets and that kind of-. Go ahead, sorry.

Nadine: 14:12

I was just gonna say, that kind of stalls our profession a little bit and it just reinforces some of the false things we've learned already. So how is that helping? How are we helping to improve the outcomes of patients?

Eric: 14:29

when we see these types of courses and we see these types of you know it's evidence-based but it's really just rehashing a lot of the stuff we already learned in school. But maybe putting an extra advanced technique label to it right, is that really doing anything extra, anything special? And if we look at the evidence, I would say no, because when we are deciding to label a hands-on technique with a tissue label to it or descriptor to it and we're not actually basing what's happening on the science of touch, right then that's not evidence-based.

Eric: 15:15

From the evidence part right, and this is something that I've been hammering around for a long time and I should probably let it go, but I won't. So too bad. The mechanisms of all of our touch are the same. It doesn't matter what you do, you're interact. You're either the mechanisms of touch. It doesn't matter whether it's how you touch somebody, you're interacting primarily with the skin and the sensory receptors in the skin and the kind of reflexive effects of of what happens with that. Without going into a big neurophysiology, neuroimmune kind of description. But people, when people teach courses, they attach a label to it's myofascial, it's craniosacral, it's lymphatic, it's circulatory, it's whatever you want to, whatever you want to call it. There's a million different names out there and they all claim to be doing something different. They're interacting with a different tissue. But if we take a step back and think, well, how can we interact with only this tissue when we're actually interacting with the skin and all the tissues all at once?

Eric: 16:18

It's way bigger than just fascia, it's way bigger than just bones and joints, because you can't get to that tissue without going through the skin so why is there this massive fascination with all these different name techniques when the science of touch is very clear that they all do the same thing, right, there's a different way of interacting with the person. Yeah, stories behind them, the narratives behind those techniques don't meet an evidential standard.

Nadine: 16:50

There's no evidence to support them yeah, but they can create buy-in, I think is what percent? Yeah, people find interesting, because if we switched over to calling it light, fingertip pressure, long cheering force, um, how much would you spend on that? To be like, oh, you just sort of fold and push, okay, done, like um, yes, we have to be critical and think, think a little bit more about that kind of stuff. I think, and especially when we communicate that to patients, what we believe shows up as we're treating and then they take that home and is that an empowering thing for them to think, or is it actually going to create their reliance on you or believe somehow that they are less capable or fragile in some way?

Eric: 17:53

Yeah, that's such a great point, nadine is that the how we think impacts how we communicate, which impacts what we, the information we provide to our patients, which impacts our expectations of outcomes, and a lot of times those, those narratives or beliefs, you know, maybe they're they don't impact the person at all, maybe it's. There's no negative outcome whatever. I don't care if I'm what you're doing it, just as long as it feels better. Right, and that is the counter argument which I get often. By often, I mean pretty much every time I have this conversation with a group is well, who cares, as long as people are feeling better? And I say, yes, the outcomes are what matters most. What's the most important thing for massage therapy appointment? The outcome. People might not care how they get there. However, if we are going to look at this from a informed consent and ethical perspective, we shouldn't be telling things to our patients that we can't defend.

Nadine: 18:55

Yeah.

Eric: 18:55

That are based on historical beliefs or based on oh. I learned this in this weekend workshop and this is just what I've been told. Yeah that's what I believe yeah was that good enough? Is that good enough for the public?

Nadine: 19:07

is that what is expected of a regulated health care profession and I would say no, but that's the way it often is yeah, and I I hope it shifts as we start talking. You know, another big word right now is trauma-informed practice. Right, and if you read through the literature on that, some people have experienced medical trauma in which medical professionals have lied to people about their bodies, misinformed them, left information out, these sorts of things. And I think we're doing exactly that every time we feed a patient pseudoscience, like it's not trauma, informed to say, oh, you've got this pulse in your body, that, oh, you didn't know about, but I do and I can take care of it for you. That's a power over me, and so I think that really needs to be considered carefully too that's such a great point.

Eric: 20:04

I love that. Would you call a power, move a power like a power over like power over.

Eric: 20:10

Yeah, yeah, yeah, yeah. That's brilliant and it's true. That puts us, as a clinician, centered. Just the exact opposite of what it says here. When we go back and look at the requirements for evidence-based practice standard is it should be patient-centered. If we are the one with the power, we're the ones that can feel and do these things to you. That's not. That's not centered on the person on the table or the person in our treatment room. I like what you said there, too, about the power over them and that us being able to feel and and and and be the the, the ones that are responsible. It makes it doesn't make sense to me in this kind of patient center shared decision-making, biopsychosocial, evidence-based all these buzzword things. Right, we use all these words and a lot of these, the pseudoscience stuff.

Eric: 21:08

We'll use those same words, but then it still puts the practitioner as the one in power exactly totally contradictory to all those other kind of buzzwords we just mentioned, and that's not in the person's best interest no, no, and it perpetuates.

Nadine: 21:28

Like how many of us have had someone come in and say, oh well, I feel out, like something's out, or like, oh yeah, I just really need, um, my energy realigned or whatever it is? Um, and now they've got that belief about themselves and they are coming back constantly to get it treated. Um, and you're slowly trying to be like, encourage them to say, you know, yeah, you maybe feel off and I'm here to support you with that, but there's nothing wrong with you. You know you're not out. What does that even mean?

Eric: 22:07

yeah, that's such a weird term too, isn't out, you know out is a feeling. It's a subjective thing, like I feel like we've all heard our back, or heard it, yeah, or a neck and you, you feel out and it doesn't move the way you want it to, but it doesn't go on anywhere. But so it's often used as a descriptor. But it's used as a descriptor, I think, by patients, so that a practitioner can then be the one to put it back where it belongs absolutely yeah and whereas that's not evidence-based.

Eric: 22:37

But what is evidence based is say okay, you know what you feel that way, like you said, you feel like it supports you. All we could really say is that I'm going to do some things Massage movement, maybe a little bit of joint mobilization stuff within our scope of practice and we'll see if that creates enough change for that to feel better. That's all we can really say. I think we can't make these big claims.

Nadine: 23:04

Yeah.

Eric: 23:06

Because there's not evidence to support that. And a lot of people might be listening to this or they've heard me say this before and they feel like we're being dismissive. And again, neither you or I are claiming that things are ineffective or all bs, but we're saying the stories and beliefs definitely are often bs.

Eric: 23:24

Yeah, and going back to what you said a few minutes ago about the trauma informed thing, which stories and beliefs definitely are often BS. Yeah, and going back to what you said a few minutes ago about the trauma informed thing, which is another, another big term that's being used right now and I feel that it's quite important, but I feel that a lot of us don't really understand what it is.

Nadine: 23:40

Right.

Eric: 23:41

Yeah, I was very fortunate that a colleague shared a trauma-informed webinar with me which I put up on my website. That was done by a psychologist with a specialty in trauma.

Nadine: 23:55

Yeah, speaking of qualified expert.

Eric: 23:58

And that's and kind of going back and thinking about it. This is somebody that you should be learning a trauma-informed course from, somebody who is probably not just an rmt I mean just you know what I mean like somebody that's an rmt, that's maybe taken a couple courses on it, that's probably not enough to be properly trauma-informed. But we should be learning from people that have expertise and extra training in a specific topic, particularly if it's something like that, where there is a lot of potential to to re-traumatize people or to make them, make them worse. Yeah, absolutely. You also mentioned to Nadine about us re-traumatizing people and about the medical stories and stuff that we we use and this is something which I just wanted to come back to and emphasize again was that the power of our words, our narratives, are very strong and we often don't realize that and when I'm teaching courses or speaking with groups, they don't realize that there could be a problem with that and it's not always a problem.

Eric: 25:14

But for those that it is a problem for it can be a big problem. And you know the world that I came from. Before I started, or I started getting into teaching and furthering my education was chronic pain and reading the chronic pain literature and spending time with people that had lived that lived with chronic pain and realizing that a lot of their coping behaviors won't use that term, but how they lived with their pain, which was oftentimes not very well. They struggled. A lot of times it was their beliefs and ideas about what was actually happening in their body that were put into them by well-meaning healthcare providers that were negatively impacting their quality of life. It was stopping them from doing things that were important and valuable to them.

Eric: 26:10

Oh yeah, I've got, you know, I've got this, this pain in my leg. Oh yeah, I've got, you know, I've got this, this pain in my leg. You know, I just you know, I've been told my nerve is, is, is is damaged beyond repair, and so every time I move, you know, I'm just going to just sever that nerve. That's the story I heard from somebody that had a disc injury and had permanent kind of sciatic type symptoms. So they didn't want to ever move, they didn't ever want to load their leg, they didn't want to do anything because they were worried every time they did that it was just going to basically cut that nerve off and they would just be completely gone, rather than saying, hey, you know what. You've got damage in your nerve. It's going to be.

Eric: 26:44

This might be something you have to manage for a very long time the rest of your life but you're not going to. Based on on the history and based on what you've been going through, it's probably. You're not going to. Based on the history and based on what you've been going through, you're not going to make it worse beyond. It's not going to get significantly worse if you get up and move around and do life. Well, let's now move this discussion towards. Maybe we can do a live critique of a course ad or of ideas, rather than than a specific course per se. We can talk about some ideas, because we haven't taken these courses so we don't know exactly what it might look like. However, a popular one which we've seen, that's shown up on social media is spinning babies seems very popular. You go the website. It's a trademarked thing and there's lots of stuff that just shows up right on the, on the first page, which makes you think is this real?

Nadine: 27:45

Yeah, cause the. You Google it and the first thing you're going to see there is spinning babies. Comfort in pregnancy and easier birth Like that's a that's a big claim.

Eric: 27:54

comfort in pregnancy and easier birth Like that's a that's a big claim I want to see some proof for that, for sure, a hundred percent, and I agree with with you with that, because that would be amazing. But if you're making big claims, you have to be able to support that with evidence.

Eric: 28:10

Yeah, we can all use clinical experience to say, oh yeah, why do this? And people have less complicated births, they have more comfortable births, less likely to have cesarean sections. But that's also. We have to be mindful that it's a very biased perspective and and when I look at the spinning babies website, there's a lot of great stuff on here. Like it's a beautiful website. It's got a lot of great things. It talks a lot about, you know, birth education and it's a lot of great stuff on here. Like it's a beautiful website. It's got a lot of great things. It talks a lot about, you know, birth education and how. It talks a lot about anti-racism and gender inclusivity and there's a lot of you know, ways of of, of of like healthy living and information about pregnancy. So I think there's a there's probably a lot of really great stuff on here. Just from looking at the website that they include. But so we're not. This critique is not about the overall value in this group, this organization, but let's just talk specifically about can you spin a baby with external techniques.

Nadine: 29:15

Right yeah, if. I was looking at this course. What am I looking for to see if I want to invest my time and energy and brain space into learning this?

Eric: 29:26

Let's talk about it. So they have workshops. What is it? What are you learning in these workshops? What are they teaching you? What are you? What are you learning in these workshops? What are they teaching you? They are oftentimes teaching you about someone. You can spin a baby through positioning and external techniques. Is that something that, as massage therapists, is that within our scope of practice? Yeah, that's a big question should we, should we actually be? Can we be doing this to, to to help, and is there evidence to support it?

Eric: 29:59

right you know, looking at the website here looks like a lot of stuff is geared towards nurses and doulas, you know, and there's massage therapists that are doulas as well, and I think the more support we can give to somebody that's pregnant, that's or, you know, a mom, during labor, just before she goes into labor, I think is is there's a lot of value in that. But can you actually spin the baby and should you spin the baby?

Nadine: 30:25

Right, I don't know. And should we? Should we be saying those sorts of things? I always think it's like should we?

Eric: 30:35

be saying these kinds of things to a patient. Yeah, because what's that? You know, if you, if you're like, oh yeah, I've been trained in this and this is what happens. And then what happens if the baby doesn't spin?

Nadine: 30:44

Right yeah.

Eric: 30:46

And then they have to do a C-section. The thing is too, that is we have to be mindful of and I just know this because you know from an outside observer and having two daughters that oftentimes the babies will not be sitting properly until just before birth, right where they will then get into the position that they need, and that happened with both my kids. So by by a sample, I saw twice where they're like oh, we're worried about this, oh, and then within the last few days, baby spins and gets ready to enter the world. Let's be critical of that. If you're taking a course, you're talking about spinning babies and the mom is concerned, the family is concerned that the baby is sitting improperly, and then they go through this whole process. The family's concerned that the baby is sitting improperly, and then they go through this whole process and the baby then rotates and baby, and then there's an, and then they have a natural birth. Is that because you did something to them or is that just something that would have happened regardless?

Nadine: 31:45

Right, yeah, yeah, it's that. Pushing on spleen six point, that acupressure point, it's like, did that help? Probably not.

Eric: 31:56

Yeah, pushing on spleen six point, that acupressure point, it's like, did that help? Probably not. Yeah, but we are highly susceptible to these types of biases and these types of these types of things. We kind of see what we want to see yeah yeah.

Eric: 32:07

so I don't know, like I see these courses and I think do you need to take this course to learn how to help somebody who is pregnant or going into labor? Are the claims are being made in it supportable by science? And you did a wonderful job. You found one paper, I think, that actually studied spinning babies and the method, and what did it find?

Nadine: 32:39

It seems to show that there may be a reduction in likelihood of cesarean, and I think it was a specific group of pregnant people, not um, not all um, but the numbers were pretty close and you brought up a good point that the the sample sizes for the spinning babies group and the non-spinning babies group were actually very different yeah, I believe there was twice as many non-spinning baby mothers spinning baby situations versus, you know, I think it was 800 that were just went through natural and about 400 that just went through like a spinning babies thing.

Eric: 33:30

So obviously there's the there's a huge variety or big difference in terms of they weren't equal. It wasn't like 400 and 400. So that can change the numbers.

Nadine: 33:42

Yeah, yeah, and because it was a review of literature too, you know it depends on the quality of what was studied as well. So we don't know for sure. And this particular paper right off the hop says, yeah, there's not any research evidence on this, and so they were trying to fill that gap. So, as it stands, I wouldn't say there's a really well supported base of evidence for that. And you head even into the spinning babies research and references page and there's one, two, three, four. There's a pilot project.

Eric: 34:21

You know there's not a lot here so you've got entire treatment registered trademark treatment that's based on four research papers and clinical experience. Is that evidence-based? And so for listeners anyone who's listening to this would that, knowing that, would you still consider investing money in something that's based on four papers and an idea that hasn't been supported? I think that's. That's something that people really need to consider before doing things like this, and you can say that for a lot of other courses too. I mean, there's a lot of other ones out there too which will make big claims, but then if you look at their research evidence, a lot of the times they'll just blast. Maybe they'll have hundreds of research papers on there If you look at their website and they'll have like all this research evidence on there. But is that evidence consistent with what they're saying in their courses or is it just kind of sound similar?

Nadine: 35:24

Yeah, and maybe something to discuss too, is like OK, so you look at this and the research isn't very strong, but something in your cycle, I'm going to take it anyway. I might consider being really clear on what you're going to get out of it. And, yeah, what you might want to consider is if I take it, what am I looking for? Is it actually just maybe getting better at working with pregnant people? Is it learning some techniques and positioning that feel good for that population, rather than, oh, I'm going to get this very specific skill.

Eric: 35:59

That's yeah, that's fantastic, because this is a question I get often too from people. Is that? Well, if I'm, you know, I'm aware of the limitations of all these different named modalities and stuff, but I just really don't feel like I'm not really sure, like I don't feel comfortable working with the jaw or the head or I'm not really comfortable working, you know, I don't really know how to. You know, maybe I want to work with more positionings for helping people the abdomen or the low back or the pelvis and I would say, yeah, you can take the stuff, Like we're not saying I'm not critiquing that you shouldn't say you shouldn't take these things because maybe it's a population that you're interested in, maybe it's an area that you're interested in that you just don't.

Eric: 36:37

You want to learn more ways of putting your hands on people or interacting with people or maybe more understandable what's happening with that particular population. I think that's great, but please, if we're going to be based on what we know and based on the requirements from the cmtbc and should be the requirements of all health care providers, professionals is be skeptical of the claims that they're making in those courses yeah and I've had people that have taken stuff from me and they are totally aware of the, the greater amount of evidence out there on touch.

Eric: 37:16

But they're like you know I really want to work on. I want to learn some nice positioning and soft touch type things. I'm just not really sure and they'll go and take like a craniosacral course or they'll go take like a visceral course, just so they can. But they were just like I just wanted to learn how to treat this area differently. But I'm going to just say say, forget all, that's all that nonsense and I'd say that's fine. You know I, I know for me a lot of the stuff that I've did in my early career was was all like myofascial stuff, like I did all like the structural integration and fascia things, and I still use a ton of that stuff. Like the technique I love because it's like slow sinking in, connecting with somebody, getting them to feel safe, putting them in some different positions which things you I didn't learn in massage school.

Eric: 38:03

It's fantastic yeah but there's no way that I'm telling them I'm releasing fascia, because there's no evidence to say that and people yeah yes, there is, there isn't, show me.

Nadine: 38:12

Yeah, yeah, yeah.

Eric: 38:14

It doesn't exist.

Nadine: 38:15

Yeah, and I think there was some discussions recently too about shiatsu too, and I have a background in shiatsu and it feels great. I learned you know different positions, different ways of applying pressure, and they're awesome. I've brought that with me and left all of the other organ diagnosis and meridian stuff behind. I don't think there's anything wrong with that.

Eric: 38:41

So that's fantastic. And you do that you still use those techniques and those approaches? Oh, absolutely.

Nadine: 38:46

I wouldn't be able to help myself, like it's just so ingrained in what I do. So a hundred percent.

Eric: 38:52

Yeah, that's, that's awesome and that's the key thing I want to. One of the key points I'd like listeners to this episode and any other episodes too, then we are kind of critiquing things is that you know, the clinical practice doesn't necessarily have to change, but the claims and the beliefs, yes, need to be evidence-based and if you are going to learn something that is beyond just normal massage techniques, so you're going to learn maybe something more population specific, you know.

Nadine: 39:24

Make sure that you.

Eric: 39:25

You do your due diligence to assess the evidence that's being used and and maybe ask the instructor what? What's your experience Like? Why should I learn from you versus from somebody else?

Nadine: 39:38

Yeah.

Eric: 39:39

And I would say that most instructors should be able to all instructors should be able to answer that yeah, and be able to say yeah, because of this is why and this is what we teach, and this is the framework, or the framework or the the base of the evidence that we come from for this course yeah, and I would encourage people to armor themselves before even that conversation and have a little look at the evidence what is sort of our understanding of this area or whatever currently?

Nadine: 40:10

and then compare that when that information comes from the instructor and say, okay, is this jiving with sort of the body of knowledge that's out there?

Eric: 40:21

and it's a big thing too that we just don't have this in our. In our curriculum there is a research course, but when I talk to new grads or students, still I'm very fortunate I get these opportunities to see kind of what's going on. You know what's happening in schools these days. There are very few of them actually do proper like a proper research course that is actually good quality, right. Oftentimes it's just like find some papers and tell us about them without actually proper critique and it's just not part of the our curriculum and and I really wish it should be in this. Maybe that's time for another discussion about you know, the benefits of us being a in a university somewhere where we would have more instructors and exposure to that, because you know most rmt's don't have that, that education or that experience, and so therefore, if you don't have that and you can't teach it, like you can't have an RMT teaching about research evidence if they don't have any experience or education on that yeah so that's.

Eric: 41:29

That's a big thing, so when we look at stuff. So, moving on to the next thing we want to talk about here, about the resources page, so the CMTc, and this is open to everybody. So if you're listening to this, doesn't matter where in the world you are, you can access. This is on the website. It's on the cmtbcca website, which is going to be gone soon and it's going to be moved to a new website which I can't remember the name, but it's the College of Complementary Health Professionals or something yeah, see, there's a lot CCP, there's a lot of letters so it'll be.

Eric: 42:04

The same information will be here, but it'll be based on a new website. So if you're listening to this and you can't find it in the CMTBCA website, I think it should probably hopefully auto direct you to the new website. Yeah, I'll probably set that up, hoping so.

Nadine: 42:13

Yeah, that's what we'll do, but we don't know yet because website, I think it should probably hopefully auto direct you to the new website. Yeah, hoping hoping.

Eric: 42:16

So that's what we do, but we don't know yet because as a recording, we don't know. However, on the cmtbc's website, public access under their standards of practice, they have an evidence-based practice thing. It actually goes through a whole fantastic section here on research evidence. What is it locating it, you know, critiquing it or evaluating it and different questions to ask. Biases are all there. It's got a whole bunch of, I think is is actually really good quality resources for rmts or anybody in the public to look at. Yeah, and it's got some great examples too about, I believe, on evaluating sources, and maybe we can discuss that in a moment. There's a great course on there called Visceral Kinetics, which is a made-up course, which I think is hilarious. So why don't you talk for a moment here, nadine, about kind of the things under the locating research and talk about some of these?

Nadine: 43:24

sort of in the top part, before you get down to the course, they've got just a ton of links on like where to go and look to start. And then I really love that they included in the evaluation piece some well established frameworks. For what questions do I ask when I'm looking at something? So maybe you've listened to this podcast but you don't remember what we talked about. So maybe you've listened to this podcast but you don't remember what we talked about. Um, right here there's the 5w, there's sift, and it just will walk you through. Here's some really key things to look for, and then they even provide more resources if that's not enough. So like this is actually a really great guide, and I also like even defining bias, because maybe that's something a lot of us haven't even thought about in research and in our thinking bias is huge.

Eric: 44:13

Yeah, that that we, we, everyone needs to admit that we're all biased. I'm biased, absolutely everyone's bias. And you know, if we're thinking about a critical thinking perspective, right, we're like, we're always thinking and being critical of our thinking and how we're thinking, right, that's kind of one of the main frameworks of that. So, if you acknowledge your bias and say, hey, you know, I have biases, this is where I'm coming from, this is what I think and this is why I think this way, then it allows you, I feel, to critique and be mindful of other information, knowing that you are coming from a specific mindset or specific thinking framework, and that is how you're going to approach new information. If we don't recognize our biases, then I think it opens us up to basically linear thinking, because we're just constantly looking for that confirmation bias. I want to see the things that I want to see. I want to find the support.

Nadine: 45:15

Yeah.

Eric: 45:16

And this is a question that we see all the time, don't we online, and we see people. Well, I'm looking for research papers to support whatever in certain here. Is that really what you're should we looking for? Should we look for something to confirm what you're should we looking for? Should we look for something to confirm what you want to find, cause you can find that.

Nadine: 45:31

Yeah, absolutely.

Eric: 45:33

You know, uh, you can find a single study that will basically support any bias.

Nadine: 45:37

Yeah.

Eric: 45:37

And that's not critical thinking, that's not evidence-based.

Nadine: 45:41

Yeah, yeah, and a technique I use um, and I have to catch myself. It really really is. You do have to catch yourself and go oh, I'm really excited about something.

Nadine: 45:51

notice, when you're like, ah, this is really good and I bet it'll make a big difference, I take whatever that phrase is and in google I'll type in that thing and then after it I write debunked and I look for all the contradictory stuff where people saying this part doesn't seem right or like there's some evidence against this bit or whatever, to give myself a much more rounded view of something and kind of calling myself out on my bias. Yeah.

Eric: 46:23

I love that.

Nadine: 46:25

Yeah, really important.

Eric: 46:26

I love that, yeah, really important. And you know, choosing learning activities, which is kind of one of the focuses of this conversation, and using resources, you know we should, you should be able to, to try to challenge yourself and and not just chase the current fad. If we wanted to go down that road of challenging polyvagal theory and fad, if we wanted to go down that road of challenging polyvagal theory just very another popular one and we wanted to evaluate the source. You know, using some of these ideas that are listed on the cmdb's website and you know we could say, well, you know these questions who is the author? What is the purpose? When was the item written or published? Where is the author? What is the purpose? When was the item written or published? Where is the content from? Why was the research written? We get asked these questions the sift Stop.

Eric: 47:14

Pause to think about the information critically. Investigate the source, Find better coverage. Is there alternative resources that cover the same area? To see if there is a consensus. Trace claims, quotes and media to the original context. Claims are cited, look into the original source and repeat the safe process. Now radar the other one they talk about on here relevance how is the information relevant? Relevant to your project authority? Who created the resource and how credible are they? Date when was the information published? Is it still accurate, relevant today? Appearance does the resource look clean and professional? Is the language formal and academic? And reason for writing why was the resource created? Was it to sell or promote something? These things here we could, so just using polyvagal, because another one of the ones that's out there, who's? Who's the person that's writing that? Who's the one that's published? All the research on that?

Eric: 48:05

yeah it's the same guy no same one guy yeah, same one person, so it has. And then you're like, okay, well, has anyone else written about it other than him? And I believe I could be totally wrong. But I believe that there's other people out there that have looked at it and they like no, it doesn't stand, it doesn't. Whatever you're saying doesn't fit yeah with what you're saying.

Eric: 48:29

So there's there's contradiction to it, and when you're looking at the the claim, so using these five w's, the sift, these radar ideas, you can kind of say, okay, well, this is all created by one person who's claiming all this research, but it's based on an idea that's got no science and there's actually stuff that contradicts these claims done by the researchers yeah, and why?

Nadine: 48:58

why did? Why is it being carried forward? Oh, there's a whole bunch of courses for sale. Oh, there's books for sale, oh, okay, and then you go. You know, and I like I've seen some interesting discussions of people starting to wise up to that and being like wait, is there anything to this? Okay, well, what if there's nothing to it? What is still valuable? And I'm not sure that for our scope of practice that it's super valuable but, say, for people in the mental health field, does it help them communicate about something in a more simplified way? Is there a benefit that way? But I wonder if there's just a better, more honest, in in keeping with being honest with people about what we know about our bodies, is there a more honest, um, research-based way to communicate with people about that? There probably is, yeah.

Eric: 49:52

There probably is. It's a great kind of I know it's kind of a rhetorical question but can we impact like? We talk a lot? You know the kind of new buzzword is nervous system and I would admit that I'm probably one of the people that was. I've been definitely used nervous system, nervous system, nervous system system probably a lot more than I should have, but you know it helped me move away from connective tissue explanations to more of a nervous system explanation. Now it's more of kind of like I think of it more of like a system, more and that we're interacting with rather than just a specific tissue or tissues. Evolution of our thinking right as time moves on. See, people talk all the time too about the vagus nerve. Can we actually do anything with the vagus nerve? Can we impact it with our touch? It's nervous system. So a lot of people think, yeah, we're impacting the nervous system. So therefore, you know I'm going to, I can impact the nervous system by working with, with, with the vagus nerve, and can you?

Nadine: 50:50

well, it looks like in very specific cases in uh, is it a seizure or something? But in a very medical place and it's not a nice massage touch, like it's a medical procedure and like apparently you can directly affect it.

Eric: 51:05

But it's that that has nothing to do with us yeah, and and that's the thing is that can you maybe create some type? We know the vagus nerve is responsible for a whole bunch of stuff yeah you know I can't remember off the top of my head what they all are. But does massage have come some type of you know impact on that? Maybe, but we can't say for sure because it's not going to be just the vagus nerve.

Nadine: 51:41

Yeah, well, and that, and I think that's the point the point is is we love things to be one thing oh it's fascia, oh it's lymph, oh it's the vagus nerve, yeah, so we're. We're complex animals, complex beings, and we can't reduce us to just one tissue or one nerve or you one process in any way. Everything is deeply connected.

Eric: 52:14

So, again, I think we do a disservice to people by trying to just be like oh, it's this one thing 100% agree with you, and it's important for us to acknowledge that when we're working with people, we're working within a human, within a whole bunch of different systems that are integrated, all working together, and to say that, oh, I'm going to take this, this polyvagal course or this vagus nerve course, rather than just talking about that specific thing.

Nadine: 52:41

why don't you have a course on.

Eric: 52:42

Like stress, like this we're going to teach you a course on how to help with stress and in this course, we're going to learn about the the fight, flight, freeze reactions we're going to talk about. You know how social engagement and the clinical environment can, can help to regulate or change, or, you know, influence, uh, our systems. Why don't we talk about courses? We'll do some touch, we'll do some some visualization, we'll do some movements. Some exercises help to calm a sensitized system, or whatever it is. You want to use whatever kind of terms you want to use. Right? That, I think, is a less wrong approach, where you're probably still doing a lot of the same thing, but you're not just focusing on the work of one guy and his one theory.

Eric: 53:27

Yeah, and yeah, polyvagal theory, theory me, it shouldn't be polyvagal hypothesis yeah because a theory means it's based on known science.

Nadine: 53:40

There's hypothesis and it's pretty well established. A theory is well established, yeah and polyvagal.

Eric: 53:44

So it's not really a theory. So that right there too is a bit of a marketing ploy yeah, marketing point point and a bit of a red flag.

Eric: 53:50

So yeah if we went and looked through all the different learning activities that were out there for massage therapists across north america. A lot of it yeah, it's kind of a lot of it is like I said before at the beginning, this podcast. A lot of it's based on pseudoscience, but there is the possibility for most of these courses that we could tweak them and turn them into something that was evidence-based If you just kind of brought in some of the science to help to explain and inform what's going on in those courses absolutely and so I think we can do better.

Eric: 54:35

We need to do better yeah, yeah.

Nadine: 54:37

I'd like to see people commit to taking what works, whatever touch, whatever techniques and doing the work to say, okay, well, what? What do we actually know?

Eric: 54:52

That would be better for the profession. Yeah, that would be better for the public, which is really the ultimate goal, because we're taking these courses so we can learn how to help people.

Nadine: 54:57

Yeah.

Eric: 54:58

And I'm sure there's people listening Maybe not, maybe people in pseudoscience don't listen to my podcast but there's people that are listening that are probably really upset by that, by that. But I would just say, if you feel defensive or you feel upset by these things, no one is attacking your clinical practice, no one is attacking what you do. But we are going to challenge the ideas behind why things, why you think things are working yeah because that needs to be based on evidence yeah and if you're, and why?

Nadine: 55:28

not take a risk on being better.

Eric: 55:30

Yeah, and if you're in BC and it's part of your learning plan, make sure that you're choosing instructors and courses that are consistent with that evidence-based practice standard, because it's actually something we're supposed to be doing. And if you haven't, visit the CMTBC's resource page, because there is a ton of stuff on here A ton of stuff on here and it actually gives you these different case scenarios. Like I said before about somebody who wants to learn a course called visceral kinetics, they're evaluating the sources from an unregulated health practitioner with no noted certifications or licenses. There's a lot of claims in here that the person finds and then they decide you follow the story they decide that they're going to keep searching for something else because this doesn't meet the standard. Yeah, if you're listening to this, please follow these steps to choose stuff that works for you.

Eric: 56:27

There's a lot of good stuff out there. We are kind of throwing some of these popular ones under the bus, but there is a lot of good stuff out there and, particularly if you use these standards and and you, you think about your thinking, you will find that a lot of stuff that you might think is evidence-based actually isn't yeah, sad, but true we need to do better yeah, that's really what it comes down to yeah, and it's, and it really is.

Nadine: 56:53

I think you you spoke to that and it's not a personal attack. But we really have to think about our patients and our society and what information we're spreading out there and what impact it could have and and that's the doing better, it's not just making one individual therapist life more difficult or challenging them in some way. Um, it's, it's about. It's about our patients in our society. For me, 100.

Eric: 57:19

I agree with you there too. Uh, nadine, that's such a great point, and just to kind of finish this off here.

Eric: 57:25

You know, to build on that, that as a profession massage therapist whether whether you're in a regulated or unregulated province in canada, whether you're overseas or you're in the united states, the goal is always to elevate the profession to the level that should be and could be. I often like to, when, when I'm talking to people, I always like to say well, my whole goal is what is? To try and put massage therapy to be what it could be, not what it currently is, to raise us to our standard. And that starts with the education we have. That starts with the courses we take. It starts with the communication. We use the words, we use the explanations, the narratives, more so than the actual hands-on the explanations, the narratives, more so than the actual hands-on. It's the bigger ideas behind that inform our hands-on.

Eric: 58:14

And if we want to be sitting at the table with physiotherapists and occupational therapists and medical practitioners, if we want to be in these allied health camps, which a lot of people do in our profession, they feel like, oh, we're the inferior people do in our profession. They feel like, oh, we're the inferior, we're the bottom. And I think we don't have to be. But until we change these ideas and until we challenge the pseudoscience that just permeates through our profession, we will not reach those other levels. We'll consistently stay down, kind of, with this imposter syndrome we're not good enough, we're not smart enough, nobody respects us, right? We have to earn that respect and by doing that we need to be. We need to jump into the evidence, deep end, fully, immerse yourself in there, yeah, and then we'll start to see these bigger systemic changes.

Nadine: 59:08

I I strongly believe that is possible yeah, yeah, and that comes through committing to a lot of the stuff that that you've got in your courses, too, of like what do we actually do, and capitalizing on those things and making making that A hundred percent.

Eric: 59:28

Yeah, what do we do and how do we do it better? That's our language, our assessments, our treatments, our self-management or home care. How do we make that evidence-based and how do we do that in a way that's consistent with what we know? We start doing that. Our profession will reach a higher level. I'm certain of that, and we do start to see it a little bit in some of the. Some of the grads are coming out from certain schools that are doing a really good job. You start to see these like higher level of understanding because they've been exposed to it and they're open to change and to challenging the status quo.

Nadine: 1:00:04

Yeah.

Eric: 1:00:05

So more of that is needed and hopefully, before you know, you and I get leave this planet. We'll, we'll, uh, we'll, we'll see. We'll see some, some, some bigger changes in throughout the profession yeah, agreed okay, we'll leave it that. Nadine, thank you very much for being here again today. That was a amazing conversation I really enjoyed and we will. I'm sure we'll have another one in the future.

Nadine: 1:00:29

Awesome, I look forward to it, thanks.

Eric: 1:00:32

Thanks again for listening. I appreciate all of you for taking the time to be here. If you enjoyed this episode, please give it a five star rating and share it on your favorite social media platforms. You can follow me on Instagram or Facebook at Eric Purvis RMT, and please head over to my website, ericperviscom to see a full listing of all my live courses, webinars and self-directed course options. Until next time, take care.